Posts Tagged ‘ward round’

On Wednesday night Dr M dropped a bombshell and then ran away whilst it detonated.

Contrary to what was said in ward round on Tuesday, “yes, it does sound like a mood disorder. We shall discuss your notes and call you in later to discuss medication”, they are now questioning my diagnosis, saying my picture doesn’t fit with their understanding of Bipolar Disorder. Now, considering this is based on a half hour conversation with me and a couple days of uncharacteristically fast (for me) mood swings, I am concerned.

They said they want me assessed by the clinical psychologist, which may take “many weeks” before they make any decisions. She isn’t sure where I should wait, here or at home, but is concerned about my safety (which to be honest she needs to be! Being in here doesn’t exactly do anything to convince you life is worth it, when you have already given up).

She said she doesn’t want to change my medication as it might influence the assessment. No mention of taking me off my current meds, which could be doing the same!

Then the meeting was over and I was left to handle the fallout alone.

I am a little shocked. They haven’t seen my Priory notes as the CMHT has lost them. I was under the care of The Priory for many months and I think they had enough time to assess me. Not make assumptions based on a short conversation and observations over a couple of days, which have obviously been influenced by an overdose and stress!

I am concerned that the change of tack seems to have come after J spoke to them. What on earth did she say, especially as she didn’t exactly know me or get the full picture as I didn’t trust her?

I can also sense what is coming. A borderline diagnosis is ahead on the tracks and coming at me fast (or slowly as it’s the NHS). I wouldn’t mind if this seemed to fit, but I am fairly familiar with the criteria and nature of the condition. It doesn’t ring true with my experience. I have no fears of abandonment – I am fiercely independent and quite happy to accept someone won’t be in my life any more, e.g. when therapy has ended. I may miss the person or thing, but not object to losing it and will not try to stop them. I do not have stormy and unreliable relationships – I have been with my partner 7 years. We argue like man and wife and our relationship is strained by this episode of illness, but I don’t love him one minute and hate him the next. My mood swings are not generally reactive and *usually* slower than those suggested for BPD. I don’t suddenly want to kill myself after bad news. Yes, I can express frustration or be upset, but not out to a level that is out of the norm or to extremes. I do not act impulsively without considering the consequences. My major suicide attempts have both been a result of a huge amount of thought and planning. In fact, aside from my mood swings I don’t think I am generally a person of extremes. I also have no past trauma, which is often involved with the condition. I could probably half meet maybe 3 or 4 criteria, but never the 5 needed by the DSM or the descriptions given in the ICD. I’m aware I am having to simplify things through lack of space or time – my thumbs will fall off if I write everything I want to, but I think you get the idea.

Also worth noting that borderline PD is one of Dr G’s specialisms and she never mentioned it to me. She tends to be pretty straight with people, so if she thought it was that then surely she would have been able to say so? She also wouldn’t have referred me to Dr P, him being the mood disorder specialist.

I can’t help but feel this is all part and parcel of the way this label can be misused. Don’t fit classic diagnosis, don’t respond to first line medication, female, suicidal and have mood swings. Oh BPD will do. Lets try and put the square peg in the round hole.

Maybe they aren’t thinking Borderline PD, but the mention of psychologists and lack of anything else even remotely close, suggests they are.

I am also frustrated at the lack of desire to do anything whilst waiting for the psychology/therapy assessment. Even if it was BPD, medication can be helpful with treatment and is often following the same kind of strategy as Bipolar II. She may in a couple months time go back to my current diagnosis, make the same changes and in the meantime I have wasted months of my life stuck on this ward. There never seems to be much desire to get you out, unless they suddenly need a bed then you can be out on your ear, recovered or not.

There are a lot of questions and no one has given any answers yet. I wrote a list of the key practical ones and handed it to my nurse to pass on yesterday, but no mention yet. I suspect I will be waiting until ward round next week.

After all this, my bloke went to see Dr N yesterday for his opinion. I thought this would help but it has made me more confused. Apparently Dr N is quite pleased I am being reassessed as he was never convinced by my diagnosis and he even suggested Dr G wasn’t. I had suspected this myself, but when I questioned Dr G on it, she said she agreed with Dr P. My bloke and Dr N apparently discussed borderline PD for a bit too. My bloke also expressed his concerns about rumination (he seems to think if I stop overthinking and forget about my illness I will be okay) and my blog came up. Apparently Dr N didn’t know I was still doing it! Surprised by this as everyone else, including the CMHT knew. I kinda feel left out of my own care again, so am wishing I had been there yesterday, although I know it is not practical.

Since then I have spent a lot of the last day or so pondering all this. I had a visit from Em in the afternoon which was lovely of her and a short break from everything.

My bloke came in the evening. It was his birthday but he wasn’t exactly full of birthday cheer. Em had got me a cake to give him, which we shared some of, but then we spent the rest of the time talking about all this. He has been doing a lot of research, trying to fix everything and find solutions (typical man).

He has been going over the rumination thing and my lack of positive thinking. I know I overthink. I even overthink good things. The problem is I always have and it feels like part of me. Questioning that feels like a direct attack. It may be an exacerbating factor, but it isn’t the only problem and I also don’t know how I could really change this. I can tell myself to stop and distract myself, but the running commentary just carries on and questions me further. I will almost overthink, overthinking. Distraction works to a point, but when I stop I just go into thinking overdrive instead and I can’t distract forever.

He has all these suggestions of how I can get better and things I need to do. Thinking and therapy techniques, supplements, the usuals of exercise etc. Many of these I do try to employ already and it is all well and good to suggest them, but at the end of the day I am: a) unwell and that can make it hard to do anything, especially when I’m in crisis and all logic goes out of the window, b) stuck in here so many of the suggestions are impractical and c) they may help to some degree but none of these things are going to fix things.

It still feels like he basically wants me to buck my ideas up. I was getting frustrated by this. I know he means well and is trying to help, but I wish he was perhaps more sensitive in his approach. He has gone from acting caring and supportively over the last couple days to criticising me again. I do wish things were all as simple as a bit of CBT, some positive thoughts, routine, eating and exercising well and some distraction. Sadly they are not.

Edit: Maybe this is unfair. The conversation was frustrating and I did feel attacked at times, but I am glad he is trying to help. Some of his suggestions were helpful. There are good bits within the bad. I do just find it hard to see them and I don’t know how much I can do right now.

Today looks pretty bleak and pointless. More waiting and the thought of another long weekend ahead is tiresome. I asked about having Nikki, coming to visit so we could have a walk around the grounds, utilities the nurse said I need to get it sanctioned by the doctor. Considering I am not on a section and would be escorted by my partner this seems unfair. I wish I could just walk out and although in theory I can, they are unlikely to let me. A section would probably beckon, if only an assessment one.

I am tempted to ask for some haloperidol! It is the only thing to ever sedate me and although it turns me into a zombie, I’d quite like to sleep away a few days in an antipsychotic-fueled daze right now. It is not practical in the real world, but in here it doesn’t matter. I don’t have any PRN written up as nothing really works.

Anyway this is pretty long and I’m scared it won’t post! I better go. Xx

I’m updating purely for something to do. I don’t think anything is going to happen today. No visitors and no ward round.

My ward round yesterday was strange. The usual scary NHS experience of a room full of people and not having any idea who most of them were. It’s not like we have any occupation or therapy here so there can’t even be OTs. Unless there were and they just do nothing! I was too nervous and hyper to ask who they were or remember if they told me their names.

I was interviewed by a psych whose job title I cannot remember, but Dr M was there too and interjected now and then. I was so nervous, that mixed with the hypomania, I became pretty incoherent, speaking so fast they were grappling to keep up. I started by trying to lay down my guidelines – respect, not being patronised and being informed. Not sure how much they listened. I was asked and talked about my diagnosis and how it came about, when I first sought help and what happened following, my last admission here, ECT, The Priory, medication and more. I talked so so much in the half hour that I became hoarse and barely stopped for breath. Felt like both hours due to the amount covered and minutes due to speed! At the end they decided that they needed more time to read my notes and discuss before they did anything and suggested that they would call me back in later so they could give me an idea of the plan. I agreed to this.

Sadly later never came. I don’t know if this is because of what happened afterwards. At 1.30 which was my original appointment time my useless social worker, J turned up uninvited and apparently unannounced. I had been asked if I wanted her there and said no, which is why they could change my time to this morning. The nurses seemed to be as confused as I was when she arrived. J saw me and proceeded to wind me up, which as I was already agitated was not helpful at all. She basically suggested I have made bad choices to end up here and it is all my fault. She doesn’t seem to recognise or acknowledge mental illness despite it being her job. She moaned about not going in ward round with me, ignoring the fact I didn’t ask her to come. Apparently it is just what happens. Well no it isn’t if I am asked and say no, surely? She then asked to see the doctor and went in without me. I am angry about this because I explicitly asked to be treated like an adult and be kept informed, but I was not involved in this conversation. I don’t know what was said, but she came out and told me they intend to RE-assess me next week before they decide to write my CPA or do anything. I got the impression I would not be involved in this latter process. She then left saying she will be checking exactly when my next ward round was so she can be there. I didn’t seem to have a choice in this matter and it seems they are generally weekly. No wonder no one gets out very fast with all this waiting to be seen.

I still hoped I would see the doctor again and they would have a plan for me, but it didn’t happen. I fear they decided just to talk to J and not bother with me, despite my wishes.

I am concerned by the mention of reassessment. Surely that is what happened yesterday? Admittedly I was hypomanic so it may not have been as clear as they would like, but for all they know I could be very manic by next week and they can’t reassess me every week before they do anything. I could be here forever. I also worry it means they do not trust or believe me. I have been feeling a little paranoid.

I moaned about J a lot to my bloke when she’d gone and said I wanted to change. He called the CMHT afterwards. Told J’s manager I wasn’t happy and hadn’t been for a while. Apparently they are meeting today to discuss and consider someone else. I’ve not been informed by anyone here about this yet, just by the bloke. Another sign of being ignored.

They asked if I wanted to complain formally. I was unsure about this, but have been encouraged by my bloke to write a letter, which I did last night. It is probably too long, but there have been so many niggling problems, as well as her general attitude, it was hard to express things. That and hypomania leads to verbiosity.

I feel a lot less hyper and giddy this morning and may be starting to come down a little. Kinda in two minds about this. Some of the hypomania has felt pretty good over the last couple days. Writing and writing. Not feeling tired. Things feeling bright and fast. It makes a change to numbing depression. But, and there is a but, I was worried about how I was coming across. It may have been to blame for the lack of response in ward round. I have also worried about things turning really nasty and the background thoughts becoming louder whilst still having this energy. Although my mood is mixed, the hypomania has been dominant meaning it is less bad.

Now I feel a little agitated, but mainly unable to think. Numb and bored. Frustrated. Wish I knew what was happening.

Gone back to m.wordpress.com today. Was trying to save data as think email is separate but this can’t use much and is easier to use except often the editing box goes out of view which can be a pain to type in. Thank god for qwerty phone and nice buttons. I found it weird at first but can do it pretty damn quick these days. Wouldn’t go back I don’t think.

I may see the doctor today after all. Named nurse felt bad for double booking and has found me a slot. Apparently someone cancelled. Don’t understand how you’d cancel your ward round unless discharged or on leave and don’t think anyone has gone since last night. Don’t mind though if it means I see the doc sooner. Still don’t know which is mine. Dr H or Dr M. I think Dr M but not sure. Dr H is on holiday anyhow so is Dr M this week either way. Older lady doctor. Looks nice from pic on wall, but I find older women scary. In my experience they often seem to look down on us young folk, try to patronise or are judgmental. Shall see. Going to try hard to make this work. Written a list of guidelines almost. Treat me as an adult, keep me informed, understand I struggle to talk and like to write, understand memory fuzzy due to ECT etc. Hopefully she will understand. Also made mood chart and written about events leading up to admission and thoughts after. Hoorah for hypomanic productivity. Hope the notes help.

I’m still writing a lot. Worked out it must be well over 15000 words by now. Could be a dissertation or novel soon the way I’m going. Wouldn’t want to type it all up, but may copy Em’s diary series and write some snippets when I’m out some day. Would be good to have a bit of a log. Had ideas about a couple of posts too, comparing this place to The Priory and things. Most of it doesn’t make for interesting reading. I’m hyper, I’m bored, I’m hyper, I’m writing lots, I’m hyper, I’m bored etc. That’s pretty much it. I lot of it is broken writing, one topic then another, then another as I can’t stick to one thing. Admittedly there are pages of introspection, feelings. thoughts and frustration too, but a lot of nonsense in between. I am just keeping my pen flowing between texts and listening to music. Writing whatever comes into my head due to hypomanic verbal diarrhoea. Keeping my head occupied at least.

An awful cliche, but it sums things up. Not only am I still all bumpy with this damn rash, but I am still struggling.

I don’t really know how I feel because I’m up and down and numb all at once. Right now, my head is fuzzy and I keep feeling very dizzy. It means I can’t really think.

I am now getting moments where I feel okay. Better than okay even. I am thinking about what I could be doing and wondering if I can get on with life. The problem is, ten minutes or two hours later, I am feeling as bad as ever again. I am suicidal and see no future at all. I am trying to control the impulses, but I find myself not wanting to. This constant swinging is frustrating as each mood undermines the other and I find myself wondering what is the point if I am going to keep having these swings. It’s just a reminder of the grim reality of this condition. This has been a problem all weekend, but I found myself just pretending everything was okay, even during the bits that it wasn’t. Damn that automatic mask!

Ward round today and it seems my NHS support is not organised or forthcoming. This scares me as my health insurance funding is being stopped in 10 weeks as I’m now diagnosed with a long term condition. Damn my new diagnosis! Aside from that, ward round was productive and I feel a bit more prepared for tomorrow’s discharge.

Yesterday, I had my appointment with Dr N. Afterwards I was left more confused and clueless than beforehand. The NHS are hopefully going to provide community support and work with The Priory but at the moment nothing seems to be organised and neither party knows what the other is doing. I was left panicking that I will be left on my own with no support. There is only one possible outcome if that happens.

Today, things are more positive. I saw Dr G and she reassures me that things are in hand. She wants everyone to work together but is aware that may not be possible or straightforward. If things don’t work out as hoped she is sure something else can be arranged that will give me some support. I just hope she is right.

My past experience of NHS mental health services, or rather my trust have been shaky at best. Dr G assures me that her experiences with them have only been positive so I hope that with her on board then maybe mine will be too. Time will tell.

As for shakiness. The Depakote seems to have given me a tremor. I can’t control my hands and it is making typing this post on my phone harder than normal. I feel a little dodgy in general today. Dr G said that is to be expected as my meds are being tweaked so much, but it still sucks. I’m coming off the Duloxetine now. Still on amitriptaline. Reducing my aripiprazole and adding the Depakote. It’s no wonder is it? No other side effects seem to be a problem so far with the Depakote but it’s early days.

Aside from talking about NHS involvement, we also talked about my diagnosis and it is confirmed as Bipolar II disorder. I am glad to have Dr G agree with Dr P and make things clear for me, but it is still sinking in. I don’t really know how I feel. I need to think about it some more. The clarity is positive though. Maybe it will bring about a better route in terms of treatment. Things have to improve. They can’t continue to be as hopeless as they have been.

I went into my ward round this morning with some notes that I’d prepared in advance. I am fed up of going in to see my consultant and not knowing what to say to her. I am fed up of going in to see my consultant and forgetting everything that I want to share with her. I am fed up of the blankness that descends the second I walk into a room with her. So I was prepared. I have been trying to write the notes for a few days and found it quite difficult, but I did get some of it pulled together and managed to get them printed off when I was home yesterday. I handed her the notes as I went in and she read them quickly. I hate that moment. I want the world to swallow me up so I don’t have to sit there as she reads the inner workings of my useless and faulty mind. We get there in the end though and she finishes reading my notes and then begins to answer some of my questions in her usual evasive manner.

She wants me to see one of the other consultants here for a second opinion. I get the impression she is a little flummoxed by me and does not know where to go now. She wants me to see Dr P, who is a specialist in mood disorders, especially bipolar disorder. She warned me he is not in any way shape or form, touchy feely and I’ve heard from others that he is very medication focussed, so will probably listen to me talk for a little while and then dole out meds, but it might be interesting to see what he has to say. I am a little scared though. I hate seeing doctors for the first time.

Aside from the second opinion, she talked about working on my care plan with her on Thursday. The idea is we will work out a plan for when I am out of hospital. She has already contacted my NHS trust with the hope they can provide me some support when I am out of The Priory, but I do not really trust them to be any help. Maybe with a respected psychiatrist or two on my side rather than just a single GP, I might have a bit more luck. We will see I guess.

Finally, she wants to refer me for some long-term psychodynamic therapy. Probably in group format, but she needs to find something suitable to refer me to. I’m a little scared at the prospect and worry that I will dread it in the same way that Alison does, but I think group therapy would be better than one to ones. I find individual therapy a terrifying prospect. I guess we will see what happens.

So.. Despite the fact I was waiting for hours this morning, it was a useful ward round. I just hope Thursday is helpful. We will see I guess…

On November 4th, the 28 day limit on inpatient care was reached with my insurance, so I was to be discharged. I had spent the days prior to my discharge panicking about it, knowing I was no better than I was when I was admitted and worrying that I wouldn’t be safe. I did not want to be discharged. I felt safe on the ward and needed the support. It felt like my safety net was being whipped away before I was ready. I couldn’t comprehend life outside of the ward. It was too scary and daunting.

It was clear I wasn’t ready to leave and Dr G said she’d have ideally kept me in for a few more weeks, but it wasn’t to be. When ward round came around that morning, I was in a state. I couldn’t think straight, was shaking and could barely talk. Her words washed over me and I couldn’t comprehend leaving. I was disappointed that she didn’t seem to acknowledge my fear. I know she told me about what support was available to me afterwards, but it didn’t feel like enough to calm my fears. I was terrified.

Later, I met with the therapy coordinator, J and this was a big help in preparing me to leave. He managed to calm me down a little and helped me to accept that I would be leaving. We looked at the options for day care and talked about the things I could do to get extra support on the outside. Eventually we settled on a programme and I had time to pack and get ready to leave before my last therapy session.

I was sad about leaving. Although most people that I had made friends with had been discharged ahead of me, there were still people I knew I’d miss when I left. I didn’t really want to say goodbyes, so it was kinda convenient that my departure coincided with dinner and everyone was in the restaurant. We took my stuff through to the car and then I got ready to go.

It was very weird being free to leave, after spending the previous four weeks being escorted everywhere by a nurse. I had taken some leave whilst I was on the ward, so it wasn’t a completely new phenomena, but it was still quite strange. It left me in a daze and this was kinda how it felt for the next few days really. It’s weird when being at home feels like a strange experience, but that was how it was. I’m still getting used to it really.